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The healthcare industry is ready to plead its case against rolling back the Affordable Care Act’s Medicaid expansion as Trumpcare heads to the U.S. Senate.

Many have long thought any effort to repeal and replace the ACA would have the easiest time passing in the U.S. House of Representatives, which finally did so by just four votes in the form of the American Health Care Act, also known as Trumpcare. But Republicans in the U.S. Senate have more favorable reviews of the ACA’s Medicaid expansion, which is what may doom the AHCA in the upper legislative chamber.

Donald Trump listens during a press conference in the Rose Garden of the White House on May 4, 2017, after House Republicans mustered just enough votes to pass their healthcare bill. (Photo: Andrew Harrer/Bloomberg)

“The Republican-controlled Senate will be the voice of reason and draft a version that will keep the Medicaid expansion and save the lives of the millions that stand to lose coverage under the House plan,” said Jerry Vitti, CEO of Healthcare Financial, a Boston-based firm that helps connect low-income beneficiaries to disability benefits.

There are 31 states that opted to expand Medicaid coverage under the Affordable Care Act, and most of them have influential Republican senators whom insurers and providers see as unlikely to end benefits for poor Americans. “Twenty Republican senators come from states that expanded Medicaid, and 16 Medicaid expansion states have Republican governors,”
Centene CEO Michael Neidorff told analysts on the company’s first-quarter earnings call, which was a week before the House voted to approve the AHCA.

Centene has been among the major health insurers that have benefited from administering benefits for states that expanded Medicaid. If House Speaker Paul Ryan and the other 216 House members who voted for Trumpcare get their way, those Medicaid benefits would go away for millions of Americans.

The biggest impact of the AHCA would be in how it rolls back Medicaid expansion, causing 24 million Americans to join the ranks of the uninsured by 2026, including 14 million by next year. Most projected to lose insurance are covered by Medicaid for poor Americans, the Congressional Budget Office reported two months ago.

Of the 75.2 million Americans covered by Medicaid, 54.7 million are enrolled in private plans, a report from consulting firm PwC indicates. Much of the recent growth has come from Medicaid expansion, benefiting not only insurance companies but hospitals, doctors and other medical care providers.

The healthcare industry isn’t going to give up these paying customers and allow Republicans to roll back Medicaid without a fight.

“We want to work with the Senate to ensure the continued strength of the Medicaid program, which delivers real value to more than 70 million Americans,” said Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, which represents large insurers in the Medicaid business, including
Anthem, Centene, Molina and
Humana. “States need adequate resources to administer an efficient, effective program that helps beneficiaries improve their health. If changes are made to criteria for who is covered by Medicaid, we need to give people more time to adjust–and more time for the individual market to stabilize.”

Aside from Trumpcare’s impact on patients who might lose coverage, the industry will be reminding U.S. Senators of the ACA’s impact on employment growth. On Friday, the U.S. labor department said the economy added 211,000 jobs in April, and more than 20,000 of them were healthcare sector jobs.

Lobbies for hospitals, clinics and medical groups are planning to push the jobs angle should the Senate decide to follow the House’s lead and roll back the Medicaid expansion.

Already, the Republican effort to derail the ACA and reduce the number of Americans with coverage could be impacting hiring in the healthcare sector.

“Healthcare employment since the beginning of the year is not the driver it once was,” Diane Swonk, founder of DS Economics told theNew York Times. Swonk described the healthcare employment trend a “residual of uncertainty regarding healthcare coverage,” the Times reported.

I've written about health care for three decades, starting from my native Iowa where I covered the presidential campaign bus rides of Bill and Hillary Clinton through the Hawkeye state talking health reform and the economy. I have covered the rise, fall and rise again of hea...